Analysis of Standard Multi-port Vs. Single Site Access for Laparoscopic Skills Training and Acquisition

Introduction: Single site access (SSA) laparoscopy is gaining popularity but is more challenging to perform than laparoscopy using multiple separate port sites. This study examined the effect of standard multi-port (MP) laparoscopic skills training versus SSA training on laparoscopic skills acquisition and performance in surgically naive individuals. Methods: Forty end-of-first year medical students were randomized into two groups. Both groups were then trained on 4 laparoscopic drills (peg transfer [Peg], cobra rope [Rope], bean drop [Bean] and pattern cutting [Pattern]) using either a standard MP laparoscopic setup (Group 1) or an SSA skill approach (Group 2). Students then practiced the skills exclusively using the approach on which they were trained until a pre-determined proficiency level was reached. Training time to proficiency and number of repetitions (reps) for each drill were recorded. Each group then crossed over to the alternate approach where the sequence was repeated. Statistical analysis was performed using a two-tailed, unpaired t-test. Results: Mean skills times and numbers of repetitions to proficiency arein the table. Four students (3 in Gr. 1, one in Gr. 2) were unable to complete the study. Total combined times to proficiency for the SSA and MP approaches was not significantly different between groups (Group 1 MP 234.0 ± 114.9 min vs Group 2 SSA 216.4 ± 106.5 min, p=0.67). The MP-trained group took less time to reach proficiency on the standard MP setup than the SSA group did on the SSA approach (119.1 ± 69.7 min vs 178.0 ± 93.4 min, p=0.058) with significantly fewer repetitions (77.6 ± 42.6 vs. 118.8 ± 54.3, p=0.027). When the SSA-trained group crossed over to the MP setup, they took significantly less time to reach proficiency for the MP setup than the standard MP-trained group (38.4 ± 29.4 min vs. 119.1 ± 69.7 min; p=0.0013), reaching proficiency in a mean of only 26.9 (range 11-65) total repetitions. Similarly, when the standard MP group crossed over to the SSA setup, they took significantly less time to reach proficiency with the SSA approach than the SSA-trained group (114.8 ±50.5 min vs. 178.0 ± 93.4 min, p=0.026) but with more total repetitions than was needed to achieve proficiency with the M-P approach (86.2± 35.2 vs 77.6 ± 42.6, p= NS).

Group

Task

Peg

Peg

Rope

Rope

Bean

Bean

Pattern

Pattern

Total

Total

Setup

Time

Reps

Time

Reps

Time

Reps

Time

Reps

Time

Reps

1 (MP Trained

MP

17.3

12.8

5.6

8.8

20.8

13.9

67.2

36.6

119.1

77.6

1

SSA

35.4

29.6

8.8

13.1

21.3

14.2

51.7

29.7

114.8

86.2

2 (SSA Trained

SSA

53.9

38.2

13.8

19.3

29.2

19.6

81.9

42.1

178.0

118.8

2

MP

5.4

4.5

0.8

1.4

4.9

3.2

28.4

18.7

38.4

26.9

MP= multiport, SSA = Single site access

Conclusions: Laparoscopic single site access skills training initially results in longer times and more repetitions to achieve proficiency than standard multi-port training, but the skills acquired transfer well to the multi-port approach. Both modalities should be used in training surgical residents for single incision laparoscopy in patients.